Active NPI
Kevin Phun, PA-C
- Physician Assistant
- Rosemead, CA
National Provider Identifier
1306593041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA60840
- Practice address
- 2418 San Gabriel Blvd
Rosemead, CA 91770-3674 - Phone
- (626) 288-7321
- NPI assigned
- Mar 2, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA60840 | CA | Primary |
Addresses
Primary practice location
2418 San Gabriel Blvd
Rosemead, CA 91770-3674
Mailing address
2418 San Gabriel Blvd
Rosemead, CA 91770-3674
Phone (626) 288-7321
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA60840 | CA | MD | Physician Assistant |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646179200000",
"number": "1306593041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2418 SAN GABRIEL BLVD",
"city": "ROSEMEAD",
"state": "CA",
"postal_code": "917703674",
"telephone_number": "626-288-7321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2418 SAN GABRIEL BLVD",
"city": "ROSEMEAD",
"state": "CA",
"postal_code": "917703674",
"telephone_number": "626-288-7321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHUN",
"first_name": "KEVIN",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-02",
"last_updated": "2022-03-02",
"certification_date": "2022-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA60840",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rosemead, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.